An exercise in futility
This is a call I ran on the Medic unit one weekend morning some years ago.
We were dispatched to a CPR in progress at one of our sister stations. This was first thing in the morning, hadn't even had coffee yet. Didn't need any until the adrenaline wore off, then.
The basic unit did a scoop & swoop with the baby, and radioed me to meet them en route. We met up about halfway between our two stations and the hospital. Our prospective drivers stopped right in the middle of the road. I wasn't going to yell about it right then. Fortunately, we had PD with us to add to the light bar display.
I jumped up in the back and my Lt. at the time, plus her driver were doing CPR on an infant. The mother was sitting in back with them, on the bench seat.
I look down and see a bluish, mottled body. I touch the baby, and she is cold. I told the crew to continue BLS measures (by protocol we cannot stop), and then I spoke to the mother. I told her that there probably wasn't anything we could do. She was crying, but quiet-far from hysterical. That would have just made things worse.
I then made my call to the hospital. While dialing I note that the baby has bruising and/or mottling on the tip of her tongue and in the center of both lips. She also has dried, bloody mucus in one of her nares.
The MD answers and I tell her that I have a 2 month-old infant, found down, having been that way for an indeterminate period of time. I relay my physical findings and say that I'd like to terminate resuscitation efforts. She tells me to try and intubate the baby and get an IV or IO. I'm shocked and appalled. I told the mother that I'd try some other interventions while we continued to the hospital, but that the situation was still grim (I wasn't going to say pointless no matter how true-it was too trite).
I went into my ET kit and picked out a 3.0mm tube and a 1 blade. I had the crew stop CPR so I could attempt intubation. Even with the stylet, that 3.0 tube was like a wet noodle in that baby's mouth. There was no way I could pass it. She was far enough into rigor mortis that the majority of her neck and head was already affected (the first regions of the body to become rigid).
In retrospect, I was glad to have my first opportunity to attempt intubation on a baby in a less-pressured situation. I am also glad that I was at least able to visualize her airway, so I knew what a real one looked like for future reference.
I abandoned my intubation effort and never had the opportunity to try a line because by then, we were already at the hospital. I was grateful, not wanting to continue the charade with the mother as a spectator.
Once in the ER, they continued to attempt resuscitation. The anesthesiologist was actually able to tube the baby, and I was in awe of that. Pretty soon, though, they quit trying. They then did a "Kiddie-gram", what we in-hospital folks call a head-to-toe x-ray of a small child-all part of the post-mortem in an unwitnessed death and/or ME's case.
I went on my way to write my report. I was also really, really glad to have a laptop at the time, on which I wrote the longest, most detailed summary I've ever written. 1.5 typed, single-spaced pages.
There were mitigating factors that I found out about after the fact, but none of them will bring the baby back. The death was suspicious, but apparently not enough that it didn't get pinned on SIDS in the end.
A few things happened afterward (still in the ER) that I was grateful for. My Chief at the time, MedicJon, brought me coffee from Wawa as a way to show his support for me. One of my favorite cops was there as part of the investigation, and I was glad to have him to talk to. Lastly, one of my co-workers was there on duty as an RN, and I was able to get a hug from her. It's really, really nice to have such a good support system when something that tragic comes your way--and it will.
We were dispatched to a CPR in progress at one of our sister stations. This was first thing in the morning, hadn't even had coffee yet. Didn't need any until the adrenaline wore off, then.
The basic unit did a scoop & swoop with the baby, and radioed me to meet them en route. We met up about halfway between our two stations and the hospital. Our prospective drivers stopped right in the middle of the road. I wasn't going to yell about it right then. Fortunately, we had PD with us to add to the light bar display.
I jumped up in the back and my Lt. at the time, plus her driver were doing CPR on an infant. The mother was sitting in back with them, on the bench seat.
I look down and see a bluish, mottled body. I touch the baby, and she is cold. I told the crew to continue BLS measures (by protocol we cannot stop), and then I spoke to the mother. I told her that there probably wasn't anything we could do. She was crying, but quiet-far from hysterical. That would have just made things worse.
I then made my call to the hospital. While dialing I note that the baby has bruising and/or mottling on the tip of her tongue and in the center of both lips. She also has dried, bloody mucus in one of her nares.
The MD answers and I tell her that I have a 2 month-old infant, found down, having been that way for an indeterminate period of time. I relay my physical findings and say that I'd like to terminate resuscitation efforts. She tells me to try and intubate the baby and get an IV or IO. I'm shocked and appalled. I told the mother that I'd try some other interventions while we continued to the hospital, but that the situation was still grim (I wasn't going to say pointless no matter how true-it was too trite).
I went into my ET kit and picked out a 3.0mm tube and a 1 blade. I had the crew stop CPR so I could attempt intubation. Even with the stylet, that 3.0 tube was like a wet noodle in that baby's mouth. There was no way I could pass it. She was far enough into rigor mortis that the majority of her neck and head was already affected (the first regions of the body to become rigid).
In retrospect, I was glad to have my first opportunity to attempt intubation on a baby in a less-pressured situation. I am also glad that I was at least able to visualize her airway, so I knew what a real one looked like for future reference.
I abandoned my intubation effort and never had the opportunity to try a line because by then, we were already at the hospital. I was grateful, not wanting to continue the charade with the mother as a spectator.
Once in the ER, they continued to attempt resuscitation. The anesthesiologist was actually able to tube the baby, and I was in awe of that. Pretty soon, though, they quit trying. They then did a "Kiddie-gram", what we in-hospital folks call a head-to-toe x-ray of a small child-all part of the post-mortem in an unwitnessed death and/or ME's case.
I went on my way to write my report. I was also really, really glad to have a laptop at the time, on which I wrote the longest, most detailed summary I've ever written. 1.5 typed, single-spaced pages.
There were mitigating factors that I found out about after the fact, but none of them will bring the baby back. The death was suspicious, but apparently not enough that it didn't get pinned on SIDS in the end.
A few things happened afterward (still in the ER) that I was grateful for. My Chief at the time, MedicJon, brought me coffee from Wawa as a way to show his support for me. One of my favorite cops was there as part of the investigation, and I was glad to have him to talk to. Lastly, one of my co-workers was there on duty as an RN, and I was able to get a hug from her. It's really, really nice to have such a good support system when something that tragic comes your way--and it will.
posted by S. @ 8:21 AM
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